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Folate
0%
0/53
Vitamin A
91%
48/53
Vitamin B12
4%
2/53
Vitamin D
Vitamin E
6%
3/53
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This patient is presenting with dermatologic abnormalities and Bitot spots suggesting a diagnosis of vitamin A deficiency. This may be secondary to anorexia nervosa in this patient.Vitamin A deficiency presents in malnourished patients (anorexic and bulimic) or states of fat malabsorption (inflammatory bowel disease and pancreatitis). Symptoms include loss of night vision, photophobia, dry skin, xerosis conjunctiva, xerosis cornea, keratomalacia, and Bitot spots. Long-term deficits from prolonged deficiency can include vision loss. Any underlying conditions should be treated, and vitamin A should be supplemented.Song et al. review the evidence regarding the diagnosis of patients with vitamin A deficiency. They discuss how this condition can still exist even in well-resourced areas. They recommend early intervention with vitamin supplementation.Figure/Illustration A is a clinical photograph that demonstrates a dry-appearing triangular patch of conjunctiva (red circle). These Bitot spots can be seen in vitamin A deficiency.Incorrect Answers:Answer 1: Folate deficiency would present with megaloblastic anemia but would not present with the ophthalmologic findings above. It is more common in alcoholics and malnourished patients. Treatment is with folate supplementation in the diet.Answer 3: Vitamin B12 deficiency can present with megaloblastic anemia, peripheral neuropathy, and other neurological sequelae such as dementia. Treatment is with identifying the underlying cause of the deficiency and providing vitamin repletion.Answer 4: Vitamin D deficiency can present with osteomalacia, depressed immune function, and in some cases depressed mood. Treatment is with vitamin D repletion or supplementation.Answer 5: Vitamin E deficiency can present with posterior column degeneration (loss of proprioception) and hemolytic anemia. This condition is rare but can be treated with vitamin supplementation.Bullet Summary:Vitamin A deficiency presents with loss of night vision, photophobia, dry skin, xerosis conjunctiva, xerosis cornea, keratomalacia, and Bitot spots.
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